The hemorrhage transition from the compensated to the decompensated stage is rapid and easily overlooked. It is generally assumed that most SPPH-associated deaths could be avoided by the prevention and timely treatment of SPPH. Most deaths resulting from SPPH occur during the first 24 h after birth. Severe complications such as hemorrhagic shock, acute respiratory distress syndrome, disseminated intravascular coagulation, acute renal failure, loss of fertility, pituitary necrosis (Sheehan syndrome), and even maternal death may be caused by delayed recognition or improper clinical procedures.
The incidence of postpartum hemorrhage (PPH) ranges from 3 to 8%, and the increasing rate is a growing public concern.
Severe postpartum hemorrhage (SPPH) is the leading cause of maternal deaths and severe maternal morbidities, accounting for 27.1% of maternal deaths worldwide, ranging from 8% in developed areas to 32% in Northern Africa. Extra vigilance during the antenatal and peripartum periods is needed to identify women who have risk factors and enable early intervention to prevent SPPH. Maternal age < 18 years, previous cesarean section, history of PPH, conception through IVF, pre-delivery anemia, stillbirth, prolonged labor, placenta previa, placental abruption, PAS, and macrosomia were risk factors for SPPH. Placenta-related problems (55.83%) were the major identified causes of SPPH, while uterine atony without associated retention of placental tissues accounted for 38.91%. SPPH was observed in 532 mothers (1.56%) among the total population of 34,178 mothers. Logistic regression analysis was used to identify independent risk factors for SPPH. SPPH was defined as an estimated blood loss ≥1000 mL and total blood transfusion≥4 units. In this study, we conducted a retrospective case-control study to determine the prevalence and risk factors for SPPH among a cohort of women who gave birth after 28 weeks of gestation between January 2015 and August 2019. To determine the prevalence and risk factors of SPPH, we analyzed data of women who gave birth in Guangzhou Medical Centre for Critical Pregnant Women, which received a large quantity of critically ill obstetric patients who were transferred from other hospitals in Southern China. Although maternal deaths are rare in developed regions, the morbidity associated with severe postpartum hemorrhage (SPPH) remains a major problem.
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